Impact Of Intracranial Pressure Monitoring On The Outcomes Of Patients With Severe Traumatic Brain Injury; A Comparative Study At The Aga Khan University Hospital Nairobi

Abstract

Introduction: Trauma is the leading cause of death in children and young adults with those patients with severe TBI having the greatest morbidity and mortality. The burden and impact is greater and outcomes worse in low and middle income countries. Majority of  patient who  of succumb to  severe TBI is a result of intercranial hypertension. There being no realiable clinical way to asses ICP, ICP monitoring is the only reliable way to asses intracranial  pressure and serve as a therapeutic endpoint.However ICP monitoring is only recommended as optional in the Brain Trauma foundation guidelines in low and medium countries.In  Kenya in since  2015 we have routinely used ICP monitoring for severe TBI.Data on the outcome of such monitoring is sparse and we set out to compare outcome data using for this cohort of patients as compared to pre monitoring cohort in quasi experimental retrospective study using the Glasgow outcome score. Methods: We compared clinical outcomes using the  Glasgow outcome scale at 6 months after discharge in patients with severe traumatic brain injury from January 2010 to 2014 (Not monitored group)  with  January 2015 to December 2021 as the (monitored group). We included patients above the age of 13 with a post resuscitation GCS of 8 or less with follow-up data for at least 6 months. Results: There was a notable decline in mortality rate form 42% to 33%, with the number one third of the extra survivors being dependent. Conclusion: ICP monitoring is a feasible in low income settings. It effective as a treatment target, but its benefits are coupled to effective therapeutic interventions. Randomized trials in low and middle income countries are necessary to address the many questions that arise. Our study is limited by its retrospective natures and  non randomized methodology as well as the  low numbers of study subjects.